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1.
Cancer Causes Control ; 34(Suppl 1): 159-169, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36840904

RESUMO

PURPOSE: The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans. METHODS: States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states. RESULTS: Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining "rural populations," and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community-academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities. CONCLUSION: Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.


Assuntos
Neoplasias , População Rural , Humanos , Atenção à Saúde , Neoplasias/epidemiologia , Neoplasias/prevenção & controle
2.
Support Care Cancer ; 31(2): 136, 2023 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-36700992

RESUMO

PURPOSE: To identify physical activity (PA) barriers and facilitators among Black and African American (Black/AA) cancer survivors that should be considered in future PA intervention development for this population. METHODS: A community advisory board (CAB) of Black/AA cancer survivors and patient advocates guided in-depth qualitative interviews (n = 19) that were completed via telephone using a semi-structured interview guide. Interviews were transcribed verbatim, and data were analyzed using directed content analysis to detail a report of PA barriers and facilitators during and after cancer treatment. The CAB reviewed and interpreted these barriers and facilitators to identify the final results. RESULTS: Survivors (n = 19) of nine different types of cancer completed interviews. PA barriers during cancer treatments included physical and psychological suffering. PA barriers after cancer treatments included social and environmental constraints (e.g., lack of access needed for PA, safety concerns, and competing priorities). PA facilitators both during and after cancer treatments included family support, faith, and support from other survivors. PA facilitators during treatment also included feeling better after doing PA, setting realistic and flexible goals, and gaining a sense of control of one's health by striving for PA goals. CONCLUSIONS: To increase PA among Black/AA cancer survivors, PA interventions are needed that address structural barriers, include the role of faith, leverage family support, highlight the psychological benefits of PA, and use goal setting.


Assuntos
Sobreviventes de Câncer , Neoplasias , Humanos , Sobreviventes de Câncer/psicologia , Negro ou Afro-Americano , Exercício Físico/psicologia , Sobreviventes/psicologia , Pesquisa Qualitativa , Neoplasias/terapia
3.
J Urol ; 208(3): 580-588, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35640276

RESUMO

PURPOSE: Optima II ("OPTimized Instillation of Mitomycin for Bladder Cancer Treatment," clinicaltrials.gov: NCT03558503) was a phase 2b trial evaluating a nonsurgical alternative as a primary treatment for nonmuscle-invasive bladder cancer (NMIBC). Patients received 6 weekly instillations of UGN-102, a mitomycin-containing reverse thermal gel. This is the first study to report on patient-reported side effects of UGN-102. MATERIALS AND METHODS: Sixty-three patients enrolled in Optima II from 20 sites. Of these 63 patients, 44 were in the cohort completing a quarterly patient-reported outcome measure assessing side effects. Changes in side effects were evaluated using the Wilcoxon signed-rank test. Associations of 3-month outcomes with demographic and clinical characteristics were examined with regression, controlling for baseline values. Ten of 44 patients (23%) were interviewed after the trial to understand tolerability for future patients making treatment decisions. Transcripts were double-coded using standard methods. RESULTS: In the patient-reported outcome measure cohort (44), 61% were men, 57% aged 65+ years and 89% were non-Hispanic White. UGN-102 did not cause decrements in patient-reported urinary symptoms, bloating/flatulence or malaise at the primary endpoint of 3 months. Sexual function mildly worsened. Future health worries improved. Demographics were not correlated with changes. Clinically, sexual function was correlated with new NMIBC and bloating/flatulence was associated with transurethral resection of bladder tumor within 12 months. In interviews, patients appreciated a nonsurgical alternative, would recommend the gel to other patients and would choose the gel over surgery. CONCLUSIONS: A nonsurgical, chemoablative gel (UGN-102) used as a primary treatment for NMIBC offers a more patient-centered therapeutic approach than standard treatments.


Assuntos
Neoplasias da Bexiga Urinária , Administração Intravesical , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Feminino , Flatulência/induzido quimicamente , Flatulência/tratamento farmacológico , Humanos , Masculino , Mitomicina/efeitos adversos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Medidas de Resultados Relatados pelo Paciente , Neoplasias da Bexiga Urinária/cirurgia
4.
Ethn Health ; 26(5): 676-696, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-30543116

RESUMO

Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.


Assuntos
Neoplasias , Racismo , Comunicação , Pesquisa Participativa Baseada na Comunidade , Grupos Focais , Disparidades em Assistência à Saúde , Humanos , Neoplasias/terapia
5.
Sex Transm Dis ; 45(4): 229-232, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29465696

RESUMO

Guidance about integration of comprehensive hepatitis C virus (HCV)-related services in sexually transmitted disease (STD) clinics is limited. We evaluated a federally funded HCV testing and linkage-to-care program at an STD clinic in Durham County, North Carolina. During December 10, 2012, to March 31, 2015, the program tested 733 patients for HCV who reported 1 or more HCV risk factor; 81 (11%) were HCV-infected (ie, HCV antibody-positive and HCV ribonucleic acid-positive). Fifty-one infected patients (63%) were linked to care. We concluded that essential program resources include reflex HCV ribonucleic acid testing; a dedicated bridge counselor to provide test results, health education, and linkage-to-care assistance; and referral relationships for local HCV management and treatment.


Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Hepatite C/diagnóstico , Saúde Sexual , Idoso , Técnicas de Laboratório Clínico , Feminino , Educação em Saúde , Recursos em Saúde , Acessibilidade aos Serviços de Saúde/economia , Hepacivirus/imunologia , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Encaminhamento e Consulta , Fatores de Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle
6.
Public Health Rep ; 131 Suppl 2: 98-104, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27168668

RESUMO

OBJECTIVE: We evaluated a hepatitis C virus (HCV) testing and linkage-to-care post-release program among detainees of small- to medium-sized jails in North Carolina and South Carolina as part of the Hepatitis Testing and Linkage to Care initiative. METHODS: An HCV testing and linkage-to-care program was implemented in selected jails in North Carolina and South Carolina from December 2012 to March 2014. Health-care workers not affiliated with the jails conducted HCV antibody (anti-HCV) and HCV ribonucleic acid (RNA) testing and linkage-to-care activities. The North Carolina jail provided universal opt-out testing for HCV; South Carolina jails initially targeted high-risk individuals before expanding to routine testing. RESULTS: Of 669 detainees tested for HCV in North Carolina, 88 (13.2%) tested anti-HCV positive, of whom 81 (92.0%) received an HCV RNA test, 66 (81.5%) of whom tested HCV RNA positive (i.e., currently infected). Of the 66 detainees with current HCV infection, 18 were referred to HCV medical care post-release and 10 attended their first appointment. Of 224 detainees tested for HCV in South Carolina, 18 (8.0%) tested anti-HCV positive, of whom 13 received an HCV RNA test. Nine of 13 detainees tested HCV RNA positive, seven detainees were referred to post-release medical care, and two detainees attended their first appointment. Overall, 106 of 893 (11.9%) detainees were anti-HCV positive. CONCLUSION: This study demonstrated that HCV testing, identification of infection, and linkage to care are feasible among jail populations. The rate of anti-HCV positivity was lower than that found in national studies of incarcerated populations, suggesting that HCV infection prevalence in jails may vary across U.S. states or regions.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Prisões , Adulto , Feminino , Hepacivirus/genética , Humanos , Masculino , North Carolina , Estudos de Casos Organizacionais , RNA Viral/isolamento & purificação , South Carolina , Adulto Jovem
7.
Public Health Rep ; 131 Suppl 2: 57-64, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27168663

RESUMO

OBJECTIVES: The national Viral Hepatitis Action Plan recommends strengthening partnerships among health departments, community-based organizations, and health-care providers for hepatitis services. We implemented a hepatitis C virus (HCV) testing and linkage-to-care program through a local health department using similar strategies reported for HIV care. METHODS: The Durham County Department of Public Health received federal funding to conduct HCV testing and linkage to care in Durham, North Carolina. HCV antibody testing with reflex RNA was offered through a sexually transmitted disease clinic, a county jail, community testing sites (including a residential substance abuse recovery program), and a homeless clinic. People with evidence of HCV infection were linked to care through an HCV bridge counselor who provided education, incentives, and transportation, and scheduled appointments with HCV specialists at nearby academic centers and on-site clinics. RESULTS: From December 2012 through February 2014, we conducted 2,004 HCV tests, of which 326 (16.3%) were HCV antibody positive and 241 (12.0%) had detectable HCV RNA. Among the 241 people with HCV infection, 178 (73.9%) were men, and 133 (55.2%) were born between 1945 and 1965. Of 241 people with chronic HCV infection, 150 (62.2%) reported ever injecting drugs, eight (2.5%) were coinfected with HIV, and 123 (51.0%) were linked to care. CONCLUSION: At the local public health level, HCV testing and linkage to care can be facilitated with additional funding and by leveraging existing programs and provider networks to deliver a coordinated system of care.


Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Hepatite C/diagnóstico , Administração em Saúde Pública , Adulto , Comportamento Cooperativo , Feminino , Promoção da Saúde , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Prevalência , Prisões
8.
Violence Against Women ; 11(3): 337-52, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16043553

RESUMO

To create appropriate intimate partner violence (IPV) services for Latino immigrants, practitioners must be aware of their needs. We conducted interviews with 100 recent Latino immigrants in a rural North Carolina county. Overall, IPV was not perceived to be a problem; however, men and women differed in their perceptions. Men were more likely to agree with IPV myths, and both men and women felt that IPV had a detrimental impact on children. Many did not know about the local domestic violence agency, and knowledge about protective orders was limited. Outreach should emphasize the seriousness of IPV, adapt content for gender-specific audiences, and increase awareness about local resources.


Assuntos
Relações Comunidade-Instituição/normas , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Atitude Frente a Saúde , Características Culturais , Feminino , Educação em Saúde/normas , Hispânico ou Latino/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades/estatística & dados numéricos , North Carolina/epidemiologia , Prevenção Primária/normas , Fatores de Risco , Apoio Social , Maus-Tratos Conjugais/prevenção & controle
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